Endoscopy Anesthetia
Endoscopy anesthesia focuses on providing patient comfort, amnesia, and stability during gastrointestinal procedures (EGD, colonoscopy, ERCP) through a continuum of sedation, ranging from moderate to general anesthesia.
8 Hours Before: No solid foods (though for Achalasia, you are likely on a liquid diet for days prior anyway)
2 Hours Before: ABSOLUTELY nothing by mouth. Stop drinking clear liquids. No gum, no hard candy, no smoking.
If you drink water right before the procedure, it may be cancelled.
The anesthesiologist or CRNA will ask about previous reactions to anesthesia
Key agents include propofol, benzodiazepines (midazolam), and opioids, with rapid-acting drugs preferred for quick recovery. Key challenges include managing shared airways and minimizing respiratory depression.
Core Components of Endoscopy Anesthesia
- Sedation Levels:
- Moderate Sedation: Patients respond to verbal commands; often used for routine procedures.
- Deep Sedation/General Anesthesia: Used for complex, therapeutic, or longer procedures (e.g., ERCP, EUS) to ensure no movement and airway control.
- Common Pharmacologic Agents:
- Propofol: The preferred agent for its rapid onset and short duration, allowing quick recovery.
- Midazolam & Fentanyl: Standard combination for moderate sedation.
- Remifentanil: Used in advanced procedures.
- Topical Anesthetics: Lidocaine spray to suppress the gag reflex.
- Procedural Considerations:
- Airway Management: High risk due to shared airway; necessitates vigilant monitoring for apnoea and desaturation.
- Patient Positioning: Typically left lateral for GI endoscopy.
- Monitoring: Continuous ECG, blood pressure, and oxygen saturation (SpO2) are mandatory.
- Risks and Complications:
- Respiratory depression/apnea from sedation.
- Aspiration, especially in non-fasted patients.
- Methemoglobinemia from benzocaine sprays.
- Hemodynamic instability.
Key Takeaways for Practice
- Propofol is increasingly favored for better patient satisfaction and faster turnover times.
- Anesthesia providers are essential for complex cases, elderly patients, or those with significant comorbidities.
- Pre-procedure assessment is crucial to tailor sedation depth.